Provider Demographics
NPI:1043714983
Name:CLOWERS, MARY LEANN (LVN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LEANN
Last Name:CLOWERS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:LEANN
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LVN
Mailing Address - Street 1:109 RED LEAF LN
Mailing Address - Street 2:
Mailing Address - City:HAWKINS
Mailing Address - State:TX
Mailing Address - Zip Code:75765-4504
Mailing Address - Country:US
Mailing Address - Phone:903-497-9976
Mailing Address - Fax:
Practice Address - Street 1:109 RED LEAF LN
Practice Address - Street 2:
Practice Address - City:HAWKINS
Practice Address - State:TX
Practice Address - Zip Code:75765-4504
Practice Address - Country:US
Practice Address - Phone:903-497-9976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX341341164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse